This protocol addresses B-lineage acute lymphoblastic leukemia where minimal residual disease (MRD) remains above 0.1% and the preceding treatment did not reach its intended goal — indicating a defined next clinical step.
The patient has B-lineage ALL with persistent or recurrent MRD above 0.1%, arising in first or later remission. Current guidance recommends changing therapy when MRD remains positive or recurs at this threshold.
Blinatumomab was deployed as a bridge to transplant in MRD-positive B-lineage ALL. This protocol is triggered when Blinatumomab fails to achieve complete molecular remission after 1 cycle — the primary target of that line. When that goal is not met, escalation is indicated.
Following MRD conversion, a transplant-based approach is part of the strategy for eligible patients. The complete sequencing, patient-selection criteria, and decision points are laid out in the full structured protocol.
DOI: 10.1182/blood.2023023568
It is recommended to change therapy in patients with persistent or recurrent MRD.
Patients with an MRD >0.1% were included either in first or later remission.
Overall, patients with MRD >0.01% after 3 blocks of standard therapy have an indication for SCT and for targeted therapies.
After conversion from MRD positive to MRD negative status using new compounds such as Blina, subsequent SCT remains the standard in younger patients with matched donor.
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